Key Points 1. Cardiac surgery–associated brain injury is common, multifactorial, and often preventable. 2. Electroencephalography can detect both cerebral ischemia or hypoxia and seizures and can measure hypnotic effect. 3. Middle-latency auditory-evoked potentials objectively document inadequate hypnosis. 4. Brainstem auditory-evoked…
Key Points 1. Intraoperative transesophageal echocardiography (TEE) plays a valuable role in interventional cardiac procedures, when used to guide transseptal puncture, evaluation of left atrial thrombus, closure of paravalvular leaks, transcatheter valve deployment, and during removal of transvenous lead extractions.…
Key Points 1. An ultrasound beam is a continuous or intermittent train of sound waves emitted by a transducer or wave generator. Ultrasound waves are characterized by their wavelength, frequency, and velocity. 2. Doppler frequency shift analysis can be used…
Key Points 1. Standard monitoring for cardiac surgery patients includes electrocardiography, invasive blood pressure, central venous pressure, urine output, temperature, capnometry, pulse oximetry, and intermittent blood gas analysis. 2. Additional monitoring is based on specific patient, surgical, and environmental factors.…
Key Points Antiischemic Drug Therapy 1. Ischemia during the perioperative period demands immediate attention. The impact of ischemia may be both acute (impending infarction, hemodynamic compromise) and chronic (a marker of previously unknown cardiac disease, a prognostic indicator of poor…
KEY POINTS 1. Isoflurane, desflurane, and sevoflurane decrease myocardial contractility, delay left ventricular (LV) relaxation, and attenuate early LV filling, but do not affect LV compliance. 2. Volatile anesthetics dilate arteriolar resistance and venous capacitance vessels, but do not alter…
Key Points 1. The coronary circulation is composed of several types of blood vessels, each with different structure and function, including the superficial conductive arteries, prearterioles, arterioles (resistance vessels), capillaries, and veins. 2. The major determinants of coronary blood flow…
Key Points 1. The cartilaginous skeleton, myocardial fiber orientation, valves, blood supply, and conduction system of the heart determine its mechanical capabilities and limitations. 2. The cardiac myocyte is engineered for contraction and relaxation, not protein synthesis. 3. Laplace’s law…
Key Points 1. The coronavirus disease 2019 (COVID-19) continues to have a devastating impact on virtually all aspects of human life, from the healthcare system to the economy, social relations, and mental health. 2. Key mechanisms that may have a…
Key Points 1. Transvenous cardiac implantable electronic devices (CIEDs) include pacemakers (PMs), implantable cardioverter defibrillators (ICDs), and cardiac resynchronization therapy pacemakers (CRT-Ps) and defibrillators (CRT-Ds). In addition to delivering antitachycardia therapy, all modern transvenous ICDs and CRT-Ds have antibradycardia pacing…